99358 -Prolonged Service w/o Direct patient contact

[Diane_Brill]

I'm confused on this because at my company we are being told we need at least 31 minutes of record review to bill 99358. That 30 minutes is no acceptable, but on the AAPC coder look up it simply states a minimum of 30 minutes. I've read somewhere that as of January 1st 2017 31 minutes was required for Medicare but we do not bill Medicare. We bill Workers Compensation. Can anyone give me clarification on this? Appreciate it.

 

[CodingKing]

I'm not sure if it helps but CPT guidelines state at least 30 minutes is needed to bill. Many codes have a 50% rule so 31 min of an hour is all that is needed.

 

[Cynthia Hughes]

prolonged service time

While a minute should seldom be an issue with coding prolonged services, the CPT manual specifically states,
"Prolonged service of less than 30 minutes total duration on a given date is not separately reported.
Code 99359 is used to report each additional 30 minutes beyond the first hour regardless of the place of service. It may also be used to report the final 15 to 30 minutes of prolonged service on a given date."

The midpoint rule does not apply because of these specific instructions for codes 99358-99359 as described in the discussion of time in the Introduction to the CPT manual: "The following standards shall apply to time measurement, unless there are code or code-range–specific instructions in guidelines, parenthetical instructions, or code descriptors to the contrary."

All that said, there may be a payer in your area that has published different requirements.

Cindy